{"id":9318,"date":"2024-06-06T01:54:07","date_gmt":"2024-06-06T01:54:07","guid":{"rendered":"https:\/\/tcmdrma.com\/%e8%84%89%e8%af%8a%e5%8c%bb%e6%a1%88%e9%9b%86%ef%bc%88%e4%b8%80%ef%bc%89\/"},"modified":"2025-05-08T15:09:50","modified_gmt":"2025-05-08T05:09:50","slug":"%e8%84%89%e8%af%8a%e5%8c%bb%e6%a1%88%e9%9b%86%ef%bc%88%e4%b8%80%ef%bc%89","status":"publish","type":"post","link":"https:\/\/tcmdrma.com\/zh-hans\/%e8%84%89%e8%af%8a%e5%8c%bb%e6%a1%88%e9%9b%86%ef%bc%88%e4%b8%80%ef%bc%89\/","title":{"rendered":"\u8109\u8bca\u533b\u6848\u96c6\uff08\u4e00\uff09"},"content":{"rendered":"

（1）<\/p>\n

某男，45岁，腿部多处被蚊虫叮咬后红肿瘙痒不退，一周前多处并未被叮咬处的皮肤也长出跟虫咬处完全一样的肿包，局部外敷及内服清热解毒药无寸效。口干苦，烧心，小便黄，双手脉无力，右关微弦紧，左关微有力。断为厥阴病，治以柴胡桂枝干姜汤，服药后红肿痒在三四日间迅速消退<\/p>\n

（2）<\/p>\n

某女，52岁，长期便秘，日常依赖灌肠通便，舌淡苔厚，右脉沉滑有力，左脉浮细无力，宜养血温肾去腑实，方用济川煎合承气汤加减7日。服药后反馈二便顺畅，取效明显，未再复诊。<\/p>\n

（3）<\/p>\n

某男，36岁，大厂工作，素来繁忙，自述消化问题，腹胀，反酸，查有胃炎。左脉偏细按至沉部方有力，右脉整体沉空而无力，问及怕冷，无晨勃，无性欲。去医院检查，未发现任何问题。此为阳虚，建议服用成药桂附地黄丸加附子理中丸。一月后反馈状况已大好，性欲恢复，仍有一些怕冷，嘱其继续服用一个月以求全功。<\/p>\n

（4）<\/p>\n

幼子四岁，晨起双颧通红，突发高热，苔白舌前部红点，脉沉实有力，流清涕，此为表寒而郁热在里，用成药防风通圣散，2小时后颧红退，转低烧，后泻下臭秽，病减半。晚间，再脉之，沉数燥，唇干裂，睡前加麦冬、玄参继服。第二日，再泻下一次后，病愈如常。<\/p>\n

（5）<\/p>\n

我的母亲自疫情以来的四年因为睡眠等问题看病无数，可以说找遍了京城的中医。大多为无效，有服用一两次感觉恶化的，还有一诊吃了有效但二诊感觉没那么好的等等。<\/div>\n
<\/div>\n
我此次回家，给她仔细把了把脉，其病机之复杂，确实少见，六部脉，除了右尺（命门）尚可外，真是各有各的问题。按脏腑辩证来看，心、肺、脾、肾、肝五脏都有问题；按气血水神四个层次看，则全部命中。气滞、血瘀、水饮、痰、情志都有问题。还好命门不衰，经失眠这么些年的消耗，底子还在。<\/div>\n
<\/div>\n
有情志问题的人，很难跟医生建立信任感，跟自己的儿子也一样。所以，我把脉诊发现的问题全部用图给她分析完以后，再帮她全面分析了以前用过的方子。大部分花重金但无效的方子是没有切中病机，只是疏肝理气安神的治法对这种病机极为复杂的患者是无效的。<\/div>\n
<\/div>\n
有一个她花了上千挂号费找的知名失眠专家开的方，吃了一次就难受吃不下去。对方除了用各类安神药以外用了栀子豉汤，此方治疗的是实证，但我母亲寸脉是无力的，药物作用反了。这种因为辩证不准的，不知道扔了多少药了。在诸多方子里面，有两张用的非常不错的方子，分别以柴胡加龙骨牡蛎汤和温胆汤来打底并加上滋阴理气去血瘀痰瘀的药，用了效果也不错，但我母亲只能断断续续地服用，一方面是用了龟板这种滋腻药很难运化，另一方面二诊后调方用药思路有所变化，效果也变差了。<\/div>\n
<\/div>\n
所有的问题跟她解释清楚后，我给她拟了一个方子，基本用药数量也到了我的极限，按照经方合方来讲加加减减合了七张经方。这种疑难病，漏了哪个层次都欠妥，比如说，如果只调气，她的血瘀、痰瘀、水饮都阻滞着，根本调不动。但是一股脑儿这么多方子，每个方子的棱角都会受到影响。所以，这类疑难病短期起效是没有问题的，但彻底治好是需要花相当长时间进行调理。还得防止患者有点风吹草动，就不想继续吃药了，难上加难。<\/div>\n
<\/div>\n
情志类疾病非常难治疗，除了对医生全面把握病机有极高的挑战以外，最难的是患者自身的执念会强烈对抗正确的治疗，表现出来就是吃什么药都不舒服，但不吃药更不舒服。而这类患者是医生最不喜欢的，所以又处处碰壁，往往阴差阳错。<\/div>\n
<\/div>\n
这大概就是人生命运之难突破，唯尽人事听天命。<\/div>\n
<\/div>\n
<\/div>\n
\n

注意：中医根据个体差异所采取的治疗手段和治疗效果亦有差异，医案分享不构成治疗建议。<\/p>\n

\n

医案编号：091-095<\/p>\n

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​<\/div>\n

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